title: Spontaneous preoperative microembolic signals detected with transcranial Doppler are associated with vulnerable carotid plaque characteristics.
abstract: OBJECTIVE
  Carotid plaque composition is associated with ipsilateral cerebrovascular events. Among patients with carotid artery stenosis, presence of microembolic signals (MES) detected with transcranial Doppler (TCD) is associated with increased stroke risk. We aimed to investigate whether MES detected with TCD in the outpatient clinic among patients scheduled for carotid endarterectomy, was associated with underlying carotid plaque composition.
  
  
  METHODS
  TCD was used to detect MES among 38 symptomatic patients scheduled for carotid endarterectomy. Measurements were performed for 30 minutes. Carotid plaques harvested during CEA were subjected to histopathological examination. Plaques from patients without spontaneous MES were compared with plaques from patients with ≥1 MES.
  
  
  RESULTS
  Median time between TCD and surgery was 4 days. At least 1 MES was detected in 10/38 (26%) patients. Five of ten (50%) patients with spontaneous MES had lipid-rich plaques, compared with 5/28 (17.2%) plaques from patients without MES (P=0.048). Luminal thrombus was observed in 6/10 (60.0%) of plaques from patients with MES compared with 7/28 (25.0%) of plaques from patients without MES (P=0.045).
  
  
  CONCLUSIONS
  Spontaneous MES were detected in 26% of symptomatic patients scheduled for CEA and were associated with unstable carotid plaque characteristics. TCD might be a useful tool to help identify patients with vulnerable plaques.
authors.affiliation: Department of Vascular Surgery, St. Antonius Hospital Nieuwegein, The Netherlands - g.w.vanlammeren@umcutrecht.nl.
authors.forename: G W
authors.initials: GW
authors.lastname: Van Lammeren
authors.forename: R H
authors.initials: RH
authors.lastname: Van De Mortel
authors.forename: M
authors.initials: M
authors.lastname: Visscher
authors.forename: G
authors.initials: G
authors.lastname: Pasterkamp
authors.forename: G J
authors.initials: GJ
authors.lastname: De Borst
authors.forename: F L
authors.initials: FL
authors.lastname: Moll
authors.forename: A
authors.initials: A
authors.lastname: Vink
authors.forename: S C
authors.initials: SC
authors.lastname: Tromp
authors.forename: J-P P M
authors.initials: JP
authors.lastname: De Vries
mesh_terms: D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000601:surgery; D016893:Carotid Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D017585:Ultrasonography, Doppler, Transcranial